Prevalence of respiratory bacterial pathogens and associated management factors in dairy calves in Taiwan.

This study aimed to investigate the prevalence at both farm-level and calf-level and to identify the risk factors of respiratory bacterial pathogens in dairy calves in Taiwan. The status of bovine respiratory disease (BRD) was evaluated by using the Wisconsin scoring system from a total of 400 pre-weaned calves from 32 different farms in Taiwan, then the nasopharyngeal swabs were collected. The prevalence of respiratory pathogens was 84.37% at farm-level and 45.50% at calf-level, and Pasteurella multocida (P. multocida) was the most prevalent pathogen. The presence of Mycoplasma bovis (M. bovis), P. multocida, Mannheimia haemolytica (M. haemolytica) and Histophilus somni (H. somni) were all higher in BRD positive calves than BRD negative calves, but only in H. somni was significant (P<0.001). Then nine farm management risk factors were analyzed by using multivariate logistic regression models to determine the risk factors of respiratory bacterial pathogens (farm and calf-level). In the result at farm-level, only unheated colostrum was significantly associated with pathogen positive farms (Odds Ratio (OR)=11.43). At calf-level, the predominant risk factor for each pathogen, M. bovis, P. multocida, M. haemolytica and H. somni, was late first colostrum feeding (OR=272.82), unheated colostrum (OR=3.41), waste milk feeding (OR=6.59) and high pneumonia treatment cost (OR=2.52), respectively. For effective preventive measures, farmer education on milk and colostrum feeding are urgently warranted.

The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.

Refractory breathlessness is a highly prevalent and distressing symptom in advanced chronic respiratory disease. Its intensity is not reliably predicted by the severity of lung pathology, with unhelpful emotions and behaviours inadvertently exacerbating and perpetuating the problem. Improved symptom management is possible if clinicians choose appropriate non-pharmacological approaches, but these require engagement and commitment from both patients and clinicians. The Breathing Thinking Functioning clinical model is a proposal, developed from current evidence, that has the potential to facilitate effective symptom control, by providing a rationale and focus for treatment.

Using Technology to Affect Influenza Vaccine Coverage Among Children With Chronic Respiratory Conditions.

INTRODUCTION: Influenza presents additional burdens for children with chronic respiratory conditions. Influenza vaccinations may reduce complications, yet approximately half of children remain unprotected. Evidence supports integration of text and e-mail into multicomponent strategies to increase influenza vaccination rates among children with chronic respiratory conditions. METHODS: A single text and e-mail message was sent to those with enabled preferences in the patient portal. A follow-up survey assessed aspects of message receipt. Surveys were completed without collection of demographics. RESULTS: A total of 3,206 messages were successfully delivered. Surveys were initiated by 107 recipients. Frequency analysis showed that text and e-mail messages were preferred forms of communication. A statistically significant relationship was found between receiving a message and receiving an influenza vaccination (p = .027). DISCUSSION: Text and e-mail messaging are cost effective and well received, and they can be easily integrated into existing systems. These methods are translatable across populations and can convey various types of messages.

Magnitude and scope of non-communicable disease-related disability: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of the review will be to identify, assess and synthesize the evidence that examines the magnitude and scope of disability including impairments, activity limitations and participation restrictions associated with four main non-communicable diseases (NCDs): cardiovascular diseases (CVDs), cancers, diabetes and chronic respiratory diseases.To systematically examine the magnitude of disability associated with CVDs, cancers, diabetes and chronic lung diseases, the questions that this review will specifically address are:To systematically examine the scope of disability associated with CVDs, cancers, diabetes and chronic respiratory diseases, the questions that this review will address are.

The burden of serious human fungal infections in Brazil.

In Brazil, human fungal infections are prevalent, however, these conditions are not officially reportable diseases. To estimate the burden of serious fungal diseases in 1 year in Brazil, based on available data and published literature. Historical official data from fungal diseases were collected from Brazilian Unified Health System Informatics Department (DATASUS). For fungal diseases for which no official data were available, assumptions of frequencies were made by estimating based on published literature. The incidence (/1000) of hospital admissions for coccidioidomycosis was 7.12; for histoplasmosis, 2.19; and for paracoccidioidomycosis, 7.99. The estimated number of cryptococcal meningoencephalitis cases was 6832. Also, there were 4115 cases of Pneumocystis pneumonia in AIDS patients per year, 1 010 465 aspergillosis and 2 981 416 cases of serious Candida infections, including invasive and non-invasive diseases. In this study, we demonstrate that more than 3.8 million individuals in Brazil may be suffering from serious fungal infections, mostly patients with malignant cancers, transplant recipients, asthma, previous tuberculosis, HIV infection and those living in endemic areas for truly pathogenic fungi. The scientific community and the governmental agencies should work in close collaboration in order to reduce the burden of such complex, difficult-to-diagnose and hard to treat diseases.

Revised listings for growth disorders and weight loss in children. Final rule.

This rule adopts, with one change, the rule for evaluating growth disorders in children we proposed in a notice of proposed rulemaking (NPRM) published in the Federal Register on May 22, 2013. Several body systems in the Listing of Impairments (listings) contain listings for children based on impairment of linear growth or weight loss. We are replacing those listings with new listings for low birth weight (LBW) and failure to thrive; a new listing for genitourinary impairments; and revised listings for growth failure in combination with a respiratory, cardiovascular, digestive, or immune system disorder. These revisions reflect our program experience, advances in medical knowledge, and comments we received from medical experts and the public.

Geriatric multidimensional assessment for elderly patients with acute respiratory diseases.

The case of an 87-year-old woman who falls at home and is admitted to the Emergency Department of an acute hospital with delirium exemplify a common situation that physicians face in their everyday clinical practice. We describe the typical context of frailty in which acute illnesses frequently present in frail elderly patients and, in particular, the relationship between comorbidity, disability and frailty. We also report the current knowledge about frailty theories and we focus on the "atypical" presentation of many acute illnesses. Major attention is devoted on delirium and on mobility impairment, two of the most common atypical symptoms of elderly frail subjects. Finally we describe the evidence on the comprehensive geriatric assessment, i.e., the method that is required to identify and understand the ultimate needs of elderly complex subjects.

[Recommendations for pediatric oxygen therapy in acute and chronic settings: Needs assessment, implementation criteria, prescription practices and follow-up]. / Recommandations pour l'oxygénothérapie chez l'enfant en situations aiguës et chroniques : évaluation du besoin, critères de mise en route, modalités de prescriptions et de surveillance.

Recommendations for acute and long-term oxygen therapy (needs assessment, implementation criteria, prescription practices, and follow-up) in children were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP2A). The Haute Autorité de Santé (HAS) methodology, based on the Formalized Consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text (arguments+recommendations) is available at the website of the French Paediatric Society: www.sfpediatrie.com.

Chart-confirmed guillain-barre syndrome after 2009 H1N1 influenza vaccination among the Medicare population, 2009-2010.

Given the increased risk of Guillain-Barré Syndrome (GBS) found with the 1976 swine influenza vaccine, both active surveillance and end-of-season analyses on chart-confirmed cases were performed across multiple US vaccine safety monitoring systems, including the Medicare system, to evaluate the association of GBS after 2009 monovalent H1N1 influenza vaccination. Medically reviewed cases consisted of H1N1-vaccinated Medicare beneficiaries who were hospitalized for GBS. These cases were then classified by using Brighton Collaboration diagnostic criteria. Thirty-one persons had Brighton level 1, 2, or 3 GBS or Fisher Syndrome, with symptom onset 1-119 days after vaccination. Self-controlled risk interval analyses estimated GBS risk within the 6-week period immediately following H1N1 vaccination compared with a later control period, with additional adjustment for seasonality. Our results showed an elevated risk of GBS with 2009 monovalent H1N1 vaccination (incidence rate ratio = 2.41, 95% confidence interval: 1.14, 5.11; attributable risk = 2.84 per million doses administered, 95% confidence interval: 0.21, 5.48). This observed risk was slightly higher than that seen with previous seasonal influenza vaccines; however, additional results that used a stricter case definition (Brighton level 1 or 2) were not statistically significant, and our ability to account for preceding respiratory/gastrointestinal illness was limited. Furthermore, the observed risk was substantially lower than that seen with the 1976 swine influenza vaccine.

Causes of hospital admission for people with dementia: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis of the literature of the factors leading to hospital admission for people with dementia in comparison with (1) people without dementia acutely admitted and (2) people with dementia in the community. RESULTS: Inpatients with dementia are at an increased risk of crisis owing to physical health-related factors, including orthopedic, respiratory, and urologic, than inpatients who do not have dementia. We also reviewed data that compared people with dementia admitted with those who were not and found that behavioral problems, such as agitation and wandering, placed people with dementia at an increased risk of being admitted. Interestingly, we also found that changes in routine and environment and increased dependency problems in several activities of daily living were associated with a higher risk of hospitalization for people with dementia. CONCLUSIONS: Many older people's crisis teams tend to focus on prevention and reducing psychiatric admissions. This review highlights the need for recognition of the physical health risks in these patients and a low threshold for early treatment in the community. This review highlights the importance of integrated working between services for older people's mental health, primary care, social welfare, intermediate care, and hospital liaison.

The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.

BACKGROUND: Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. METHODS: This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. RESULTS: Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. CONCLUSIONS: Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.

[Perioperative management of Parkinson's disease]. / Manejo perioperatorio de la enfermedad de Parkinson.

One of the particular characteristics of Parkinson's disease (PD) is the wide clinical variation as regards the treatment that can be found in the same patient. This occurs with specific treatment for PD, as well as with other drug groups that can make motor function worse. For this reason, the perioperative management of PD requires experience and above all appropriate planning. In this article, the peculiarities of PD and its treatment are reviewed, and a strategy is set out for the perioperative management of these patients.

Health care utilization & costs for cystic fibrosis patients with pulmonary infections.

PURPOSE: To examine patterns of health care utilization and costs among cystic fibrosis (CF) patients with pulmonary infections. DESIGN: Retrospective administrative claims database analysis. METHODOLOGY: We used administrative claims data (including both medical and pharmacy claims) to examine health care utilization and costs among CF patients with pulmonary infections over one year. We conducted a subgroup analysis in which we examined selected outcome measures among patients with tobramycin for inhalation (TIS) prescriptions by the number of TIS prescriptions filled. PRINCIPAL FINDINGS: Among 1,064 CF patients identified with pulmonary infections, 80% had at least one CF-related office visit, 34% had a CF-related hospital stay, and 95% filled at least one prescription over one year. Total annual CF-related health care costs averaged $29,000 plus $20,000 for prescription drugs. In the subgroup analysis, there was a trend towards longer lengths of stay and higher inpatient costs with fewer numbers of TIS prescriptions filled. CONCLUSION: CF patients with pulmonary infections have substantial levels of health care utilization and costs.

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul.

BACKGROUND: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. OBJECTIVES: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. METHOD: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. RESULTS: The three most prevalent reported general health problems were associated with genito-urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one-third of the subjects had not been to the dentist within the previous 5-10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two-thirds of denture-wearing subjects wore their dentures only during eating. CONCLUSIONS: There was significant perceived dental treatment and care need for the sample population of elderly studied.

Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network.

BACKGROUND: We conducted a prospective, multicenter investigation of incidence, management and outcome of neonatal acute respiratory disorders (NARD), and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units (NICUs) in a Chinese neonatal network. METHODS: Data were prospectively collected in 2004 - 2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life. RESULTS: A total of 2677 NARD was classified (20.5% of NICU admissions). There were 711 (5.44%) with respiratory distress syndrome (RDS), 589 (4.51%) pulmonary infection, 409 (3.13%) meconium aspiration syndrome, 658 (5.03%) aspiration of amniotic fluid and 239 (1.83%) transient tachypnoea. Meconium aspiration syndrome had the highest rate with fetal distress, transient tachypnoea from cesarean section, and RDS with maternal disorders. Assisted mechanical ventilation was applied in 53.4% of NARD, and in above five disorders with 84.7%, 52.3%, 39.8%, 24.5%, and 53.6%, respectively. Corresponding mortality in these disorders was 31.4%, 13.6%, 17.8%, 4.1% and 5.0%, respectively. Surfactant was provided to 33.9% of RDS. In all RDS infants, the survival rate was 78.8% if receiving surfactant, and 63.4% if not (P < 0.001). CONCLUSIONS: This study provided NICU admission-based incidence and mortality of NARD, reflecting efficiency of advanced respiratory therapies, which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels, justifying efforts in upgrading standard of care in emerging regions through a collaborative manner.

Associations of morbidity in the underweight.

BACKGROUND/OBJECTIVES: There is little research on the demographic characteristics and morbidity of people categorized as 'underweight' from their body mass index (BMI) although they have often been shown to have greater mortality. This uncertainty makes it difficult to determine whether to include or exclude these individuals when estimating the health and mortality impacts of BMI. This project compares the demographic characteristics and morbidity patterns of the underweight with those of acceptable weight and the overweight. SUBJECTS/METHODS: Data on 10 243 community-living residents from the Health Survey for England (2003) were used. Logistic regression models were constructed to compare demographic, biochemical and anthropometric factors in the underweight (BMI<18.5) with those classified as acceptable weight (BMI 18.5-24.9) or overweight (BMI 25.0-29.9). RESULTS: Univariate analyses found, when compared with other BMI categories, underweight individuals were significantly younger, more likely to smoke, alcohol abstainers, inactive, poorer and were less likely to be ethnically white (all P<0.001). U-shaped relationships between BMI and activities of daily living, respiratory disease, physical activity and mental health variables were seen. In multivariate analysis, the fewest number of significant differences in demographic and morbidity factors were between the underweight and those of acceptable weight. CONCLUSIONS: We recognize that these are cross-sectional data and exclude individuals in institutional settings, but these findings are important. Overall, we could not conclude that the underweight were less healthy than individuals in the other BMI categories. We cannot therefore recommend that the underweight should be excluded from analyses that examine the effects of obesity on mortality.

Vigilancia de la resistencia a las drogas antituberculosas en Honduras / Surveillance of antituberculous drug resistance in Honduras

Antecedentes. Determinar la resistencia primaria, adquirida y multidrogoresistencia del Mycobacterium tuberculosis a drogas de primera línea en Honduras. Pacientes y Métodos. Estudio a nivel nacional de drogoresistencia a drogas antifimicas realizado conforme las directrices de la Organización Mundial de la Salud y de la Unión Internacional contra la Tuberculosis y Enfermedades Respiratorias. Resultados. Se obtuvo un total de 530 casos fueron analizados, 457 nuevos y 73 tratados. Obteniéndose una resistencia para Isoniacida, Rifampicina y Multidrogoresistencia (MDR) de 5.9%, 2.2% y 1.75% respectivamente en casos nuevos y 24.7%, 20.5% y12.32% para casos previamente tratados. Conclusión. Honduras presenta porcentajes moderados de resistencia y MDR a pesar de la existencia de factores de riesgo, como ser principalmente la presencia del VIH, la creciente migración a Estados Unidos...

Keys to successful management of patients with allergic rhinitis: focus on patient confidence, compliance, and satisfaction.

OBJECTIVE: The American Academy of Otolaryngic Allergy (AAOA) convened an expert, multidisciplinary Working Group on Allergic Rhinitis to discuss patients' self-treatment behaviors and how health care providers approach and treat the condition. PROCEDURES AND DATA SOURCES: Co-moderators, who were chosen by the AAOA Board of Directors, were responsible for initial agenda development and selection of presenters and participants, based on their expertise in diagnosis and treatment of allergic rhinitis. Each presenter performed a literature search from which a presentation was developed, portions of which were utilized in developing this review article. SUMMARY OF FINDINGS: Allergic rhinitis is a common chronic condition that has a significant negative impact on general health, co-morbid illnesses, productivity, and quality of life. Treatment of allergic rhinitis includes avoidance of allergens, immunotherapy, and/or pharmacotherapy (ie, antihistamines, decongestants, corticosteroids, mast cell stabilizers, anti-leukotriene agents, anticholinergics). Despite abundant treatment options, 60% of all allergic rhinitis patients in an Asthma and Allergy Foundation of America survey responded that they are "very interested" in finding a new medication and 25% are "constantly" trying different medications to find one that "works." Those who were dissatisfied also said their health care provider does not understand their allergy treatment needs and does not take their allergy symptoms seriously. Dissatisfaction leads to decreased compliance and an increased reliance on multiple agents and over-the-counter products. Furthermore, a lack of effective communication between health care provider and patient leads to poor disease control, noncompliance, and unhappiness in a significant portion of patients. CONCLUSIONS: Health care providers must gain a greater understanding of patient expectations to increase medication compliance and patient satisfaction and confidence.